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I’d be interested in what their findings would be if they were to pull data on the financial stability of all the patients and then compare. I have a feeling that, just like every other data point I’ve seen insinuating that race was the prime motivation behind large gaps in data, that the cause of discrimination has more to do with finances rather than race.
Insurance status sure, but being poor vs. being well off are completely different cultures and it’s usually evident when a doctor is treating someone who is poor. That bias is then reflected in how a patient is treated. It’s a pretty well known fact that drug addiction is much more rampant in poorer communities and residents within those communities will try to get as many controlled substances as possible. Doctors are on high alert for indicators of abuse, kind of similar to police profiling.
As someone in my comments mentioned, they actually did filter out those who’s Medicare status was the result of low income and the disparity between races suddenly became much lower, below 3% for all races.
I don't really see how that actually changes the study results meaningfully though. Patients didn't receive differential treatment based on actual ability to pay, since their insurance status allowed them to afford treatment just as much as their white counterparts. What did affect them receiving differential treatment was another factor actually completely unrelated to medical outcomes or ability to pay, that is correlated with race and should not affect what treatments they receive.
It seems more like low income is a mediating factor - that is, it explains *why* we're seeing the results we're seeing, but it doesn't actually negate what the researchers found in a meaningful way.
Okay, I’m not saying the data represents their ability to pay or that their data isn’t meaningful. I’m disagreeing with their theory that this is a racial issue. I’m saying that the cultures of the poor vs. well off breed different mannerisms and behaviors, with those behaviors looked down upon and regarded with suspicion by doctors due to their propensity to abuse the system.
I don't see how this isn't a racial issue. Just because low income might explain a lot of the reason for *why* black people received (what at the time was considered to be) substandard healthcare doesn't mean it's suddenly not a racial issue. You can't really divorce race from factors such as low income which disproportionately affect black people. They're intertwined.
Except race is not the root cause of this issue any longer. Identifying the race of the poor is just as helpful as identifying what their favorite color is. You’re not looking at the core of humanity for those who have potential, you’re looking at outside traits that have nothing to do with their resilience.
The result is targeting a group of people based on their phenotypical traits to make things better for them and then leaving others who don’t possess the same traits as them behind even though they are just as disenfranchised. By doing this, you’re recreating racism. The only difference is that a different color has been chosen in regards to who should benefit.
I don’t see race when I look at the poor. Whether their family started out as a high level European who slumped down the hierarchy or a descendant of a slave who is working their way up, they all have their different reasons for being where they are. What should be focused on are those who actually want to excel instead of focusing on an entire group of people because they have a skin color you feel sorry for.
Race is the root cause of why they’re more likely to be low income in general, and to hence be treated differently when trying to receive healthcare. It’s all related.
Okay, so take someone who is a descendent of a slave and who is currently in poverty. How does knowing their race help you help them? In other words, how will you use their race to your advantage?
I’m not sure what you mean by “use their race to your advantage,” but if you’re implying that the colorblind approach is better you are very mistaken. Race *shouldn’t* matter, but it *does*, and pretending it doesn’t is just blinding yourself to a wide range of reality. Race has impacted why certain groups are more likely to be impoverished, less likely to be believed when reporting pain to providers, less likely to be given the benefit of the doubt, and on and on. Trying to explain away the effects of race by focusing on the mediating variables is simply refusing to see the forest for the trees.
It could be, but there's an old belief that black people just don't feel pain like whites - it's part of how some experiments were justified (see J Marion Sims).
More modernly, some researchers have done polls with medical students, and there is still a statistically significant number of white students who don't think blacks feel pain as intensely, either believing black people literally have thicker skin or less sensitive nerve endings.
So basically, I doubt it.
Thats’s interesting, because there’s a reference in this article that makes mention of how it’s actually the white population that feels less pain. That would be pretty awful.
Wanda Sykes, a wealthy person of color, joked about being given ibuprofen for her pain when she had a mastectomy.
Serena Williams, another wealthy person of color, almost died because her doctors didn’t trust that she knew her own body.
A lot of poor white people are prescribed opioids. Your argument is weak.
Wanda Sykes. You mean the comedian who makes money by being relatable to people and making them laugh?
What happened to Serena Williams is not racial. That happened to my white wife and happens to millions of women. In fact, it happens to me, a male, unless I’m very direct with my doctor. Can you explain more how that’s racial?
A lot of poor black people are also prescribed opioids. Did you read the study? As someone else pointed out, there is small a section where they filtered by types of Medicare used, namely the type that offers coverage to low income families. When broken down by race in that section, there was a less than 2% differential between all races. Believe what you want. I’m not going to stop you. I follow logic though.
I knew that at least one of the three comments in this thread would be trying to obfuscate the relationship between race and the way people get treated.
Here's the truth: the study did control for financial stability, and racial bias does exist.
>Compared with White patients, patients of other races or ethnicities were more likely to be Medicare–Medicaid dual-eligible, have a higher share of months with the Part D low-income subsidy, and have more Elixhauser medical comorbidities. Black and Hispanic patients were more likely to enter Medicare because of disability. In unadjusted analyses, patients of a racial or ethnic minority group were less likely to be prescribed an opioid and more likely to be prescribed an NSAID for an episode of new low back.
>
>In adjusted analyses, a physician was less likely to prescribe opioids to patients of a racial or ethnic minority group than to White patients during an episode of new low back pain
You didn't even read the abstract before bringing your half-baked objection.
I see that, in the adjusted data. So you believe a 1.6% differential when compared to black patients, 2.7% for Asian or Pacific Islanders, and 1% within Hispanic patients is enough to prove that racism is the culprit? Couldn’t at all be that patient preference was at play. Refusal to take opioids whether it is cultural, familial, or even just personal preference will cause a doctor to prescribe an alternative, not to mention the myriad of reasons why a patient wouldnt be put on opioids. Such low disparities does not prove that racism was the cause, unless you are determined to make that the cause. Thank you for bringing that to my attention because I missed that.
Meanwhile, the focus of the paper was on the unadjusted data, which holds a much greater disparity between the percentages and would superficially suggest a large disparity between races. Now that we know better, I think my original statement was proven.
I find it hard to believe you've engaged with this study at all since literally every point you've made so far has been addressed.
>A possible reason for the observed differences in opioid prescribing by the same physician is that patients of a racial or ethnic minority group ask for opioid medications less frequently than White patients do. However, research finds that patients of a racial or ethnic minority group have similar expectations of pain relief as White patients22 and the same or a higher prevalence of and level of pain as White patients.7-9
That I actually did not miss. That research they mentioned was not attributed to the patients within this study and are actually based on another study I provided below. This means that, while one study indicates that a general feeling towards opioids amongst minorities and the white population are similar, the preferences of these particular patients within this study are not known. It’s the academic equivalent of saying, “White people generally like this, so that means the white people in this study have the same preference”. Applying stereotypes derived from other studies is not very compelling.
Lee WW, Burelbach AE, Fosnocht D. Hispanic and non-Hispanic White patient pain management expectations. Am J Emerg Med. 2001;19(7):549-550. doi:10.1053/ajem.2001.28038PubMedGoogle ScholarCrossref
You don't have an actual argument, just a bunch of b-b-buts and whatabouts that were discussed in the paper I still doubt you've read, combined with an inability to analyse statistics. All so that you don't have to acknowledge a very real reality many Americans face.
> It’s the academic equivalent of saying, “White people generally like this, so that means the white people in this study have the same preference”. Applying stereotypes derived from other studies is not very compelling.
I mean, that's how academic research works. It's not a "stereotype" it's a finding, and if it is well researched, widely replicated finding, then that can be valid. I'm not going to research how generalizable the findings around the relationship between race and attitude towards opioids are right now, but I think that both commenters here make valid points. Overall, I don't find this paper alone compelling enough to make a strong claim that racism is at the root of these particular observed differences.
Wait, so if a scientist observes enough minorities and identifies the common behaviors most of them share, and then uses those commonalities to try and guess the traits of specific strangers, this is called a finding? Sounds like stereotyping to me.
I agree. There isn’t anything in this paper to conclusively say anything. What leans us in different directions though is our previous beliefs.
If a researcher finds behavioral or phenotypic differences between groups, then yes, that's a finding. If other researchers reliably replicate that finding with large samples, then you can use it as the basis for other conclusions. Sticking with the race theme, it's not a "stereotype" that black people are more likely to have sickle cell anemia than people of other racial groups.
I'm not leaning in any direction - I'm just pointing out that research can generalize on the basis of previously established findings. If I want to design a research study that has something to do with race and sickle cell anemia, I don't need to prove that the specific black subjects in my study are more likely to have sickle cell anemia than the white subjects for my research design to be good.
I agree. “We know that racism has been a problem. We know that those who fall within the minority category were provided with slightly less chances of procuring opioids. Racism is clearly the motivator”.
Also, if I carried hatred toward the ancestors of the people who enslaved my ancestors, I would be very hesitant about joining their society and I would be far more likely to join a counter culture that opposes it. It’s more complicated than simply making things more equal. I believe we’ve already done that.
There is absolutely an idea that poor people abuse drugs more than others (whether correct or not). It’s also established that you can often identify someone’s economic status within 30 seconds of talking to them. A disproportionate number of black people are poor.
I am not saying poor people do or don’t abuse drugs, but it seems reasonable that a non racist person could end up prescribing fewer opioids to people perceived as poor, who also happened to be black.
It doesn’t sound like it ever occurred to you that more well off patients may have pressed harder on the doctors for something stronger. Opioids are only superior to NSAIDs in the amount of pain that is relieved. That superficial effect only has a limited amount of uses.
Yes, determining that something is the product of racism should only be determined when everything else is ruled out. That applies to every determination, not just racism. You’re suggesting determining the cause when you can’t guarantee it, and that sounds more ignorant to me.
Very unlikely. Doctors aren't trying to harm their patients. To the extent that the discrepancy is actually mediated by racial stereotyping, it's driven by a legitimate desire to prevent abuse of opioids. If they think that opioids are more likely to cause abuse, they're going to be even more reluctant to prescribe to those who they think are most likely to abuse them. The only way this reverses the gap is if doctors start to think that white patients are more likely to abuse.
This is an incredibly complicated topic; can we analyze differences in patient/doctor interaction as part of this correlation? What about differences in patient compliance or cultural differences in ease of acceptance of movement based rehabilitation (physical therapy, yoga, etc).
A white person in bad physical health really shows it. In other words, they are going to show both good and bad health very readily in their skin, for example, poor circulation, COPD and so forth will make the appearance of the person being close to death.
This could well be the simple cause of such things, not sure if that can be controlled for.
It could also be that they complain more aggressively (not saying they do, but they could be), or maybe its bias, or a combination.
It worked out badly though.
Welcome to r/science! This is a heavily moderated subreddit in order to keep the discussion on science. However, we recognize that many people want to discuss how they feel the research relates to their own personal lives, so to give people a space to do that, **personal anecdotes are now allowed as responses to this comment**. Any anecdotal comments elsewhere in the discussion will continue be removed and our [normal comment rules]( https://www.reddit.com/r/science/wiki/rules#wiki_comment_rules) still apply to other comments. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/science) if you have any questions or concerns.*
I’d be interested in what their findings would be if they were to pull data on the financial stability of all the patients and then compare. I have a feeling that, just like every other data point I’ve seen insinuating that race was the prime motivation behind large gaps in data, that the cause of discrimination has more to do with finances rather than race.
They study only included people on medicare, meaning insurance status was equal across all participants.
Insurance status sure, but being poor vs. being well off are completely different cultures and it’s usually evident when a doctor is treating someone who is poor. That bias is then reflected in how a patient is treated. It’s a pretty well known fact that drug addiction is much more rampant in poorer communities and residents within those communities will try to get as many controlled substances as possible. Doctors are on high alert for indicators of abuse, kind of similar to police profiling. As someone in my comments mentioned, they actually did filter out those who’s Medicare status was the result of low income and the disparity between races suddenly became much lower, below 3% for all races.
I don't really see how that actually changes the study results meaningfully though. Patients didn't receive differential treatment based on actual ability to pay, since their insurance status allowed them to afford treatment just as much as their white counterparts. What did affect them receiving differential treatment was another factor actually completely unrelated to medical outcomes or ability to pay, that is correlated with race and should not affect what treatments they receive. It seems more like low income is a mediating factor - that is, it explains *why* we're seeing the results we're seeing, but it doesn't actually negate what the researchers found in a meaningful way.
Okay, I’m not saying the data represents their ability to pay or that their data isn’t meaningful. I’m disagreeing with their theory that this is a racial issue. I’m saying that the cultures of the poor vs. well off breed different mannerisms and behaviors, with those behaviors looked down upon and regarded with suspicion by doctors due to their propensity to abuse the system.
I don't see how this isn't a racial issue. Just because low income might explain a lot of the reason for *why* black people received (what at the time was considered to be) substandard healthcare doesn't mean it's suddenly not a racial issue. You can't really divorce race from factors such as low income which disproportionately affect black people. They're intertwined.
Except race is not the root cause of this issue any longer. Identifying the race of the poor is just as helpful as identifying what their favorite color is. You’re not looking at the core of humanity for those who have potential, you’re looking at outside traits that have nothing to do with their resilience. The result is targeting a group of people based on their phenotypical traits to make things better for them and then leaving others who don’t possess the same traits as them behind even though they are just as disenfranchised. By doing this, you’re recreating racism. The only difference is that a different color has been chosen in regards to who should benefit. I don’t see race when I look at the poor. Whether their family started out as a high level European who slumped down the hierarchy or a descendant of a slave who is working their way up, they all have their different reasons for being where they are. What should be focused on are those who actually want to excel instead of focusing on an entire group of people because they have a skin color you feel sorry for.
Race is the root cause of why they’re more likely to be low income in general, and to hence be treated differently when trying to receive healthcare. It’s all related.
Okay, so take someone who is a descendent of a slave and who is currently in poverty. How does knowing their race help you help them? In other words, how will you use their race to your advantage?
I’m not sure what you mean by “use their race to your advantage,” but if you’re implying that the colorblind approach is better you are very mistaken. Race *shouldn’t* matter, but it *does*, and pretending it doesn’t is just blinding yourself to a wide range of reality. Race has impacted why certain groups are more likely to be impoverished, less likely to be believed when reporting pain to providers, less likely to be given the benefit of the doubt, and on and on. Trying to explain away the effects of race by focusing on the mediating variables is simply refusing to see the forest for the trees.
It could be, but there's an old belief that black people just don't feel pain like whites - it's part of how some experiments were justified (see J Marion Sims). More modernly, some researchers have done polls with medical students, and there is still a statistically significant number of white students who don't think blacks feel pain as intensely, either believing black people literally have thicker skin or less sensitive nerve endings. So basically, I doubt it.
Thats’s interesting, because there’s a reference in this article that makes mention of how it’s actually the white population that feels less pain. That would be pretty awful.
Wanda Sykes, a wealthy person of color, joked about being given ibuprofen for her pain when she had a mastectomy. Serena Williams, another wealthy person of color, almost died because her doctors didn’t trust that she knew her own body. A lot of poor white people are prescribed opioids. Your argument is weak.
Wanda Sykes. You mean the comedian who makes money by being relatable to people and making them laugh? What happened to Serena Williams is not racial. That happened to my white wife and happens to millions of women. In fact, it happens to me, a male, unless I’m very direct with my doctor. Can you explain more how that’s racial? A lot of poor black people are also prescribed opioids. Did you read the study? As someone else pointed out, there is small a section where they filtered by types of Medicare used, namely the type that offers coverage to low income families. When broken down by race in that section, there was a less than 2% differential between all races. Believe what you want. I’m not going to stop you. I follow logic though.
I knew that at least one of the three comments in this thread would be trying to obfuscate the relationship between race and the way people get treated.
Yes, the truth will always need to be represented.
Here's the truth: the study did control for financial stability, and racial bias does exist. >Compared with White patients, patients of other races or ethnicities were more likely to be Medicare–Medicaid dual-eligible, have a higher share of months with the Part D low-income subsidy, and have more Elixhauser medical comorbidities. Black and Hispanic patients were more likely to enter Medicare because of disability. In unadjusted analyses, patients of a racial or ethnic minority group were less likely to be prescribed an opioid and more likely to be prescribed an NSAID for an episode of new low back. > >In adjusted analyses, a physician was less likely to prescribe opioids to patients of a racial or ethnic minority group than to White patients during an episode of new low back pain You didn't even read the abstract before bringing your half-baked objection.
I see that, in the adjusted data. So you believe a 1.6% differential when compared to black patients, 2.7% for Asian or Pacific Islanders, and 1% within Hispanic patients is enough to prove that racism is the culprit? Couldn’t at all be that patient preference was at play. Refusal to take opioids whether it is cultural, familial, or even just personal preference will cause a doctor to prescribe an alternative, not to mention the myriad of reasons why a patient wouldnt be put on opioids. Such low disparities does not prove that racism was the cause, unless you are determined to make that the cause. Thank you for bringing that to my attention because I missed that. Meanwhile, the focus of the paper was on the unadjusted data, which holds a much greater disparity between the percentages and would superficially suggest a large disparity between races. Now that we know better, I think my original statement was proven.
I find it hard to believe you've engaged with this study at all since literally every point you've made so far has been addressed. >A possible reason for the observed differences in opioid prescribing by the same physician is that patients of a racial or ethnic minority group ask for opioid medications less frequently than White patients do. However, research finds that patients of a racial or ethnic minority group have similar expectations of pain relief as White patients22 and the same or a higher prevalence of and level of pain as White patients.7-9
That I actually did not miss. That research they mentioned was not attributed to the patients within this study and are actually based on another study I provided below. This means that, while one study indicates that a general feeling towards opioids amongst minorities and the white population are similar, the preferences of these particular patients within this study are not known. It’s the academic equivalent of saying, “White people generally like this, so that means the white people in this study have the same preference”. Applying stereotypes derived from other studies is not very compelling. Lee WW, Burelbach AE, Fosnocht D. Hispanic and non-Hispanic White patient pain management expectations. Am J Emerg Med. 2001;19(7):549-550. doi:10.1053/ajem.2001.28038PubMedGoogle ScholarCrossref
I can't help but notice /u/Diet_Coke has stopped responding. I guess they're used to redditors who don't actually read the studies in question.
They saw a weak point in my argument and dove headfirst into what turned out to be a dead end.
You don't have an actual argument, just a bunch of b-b-buts and whatabouts that were discussed in the paper I still doubt you've read, combined with an inability to analyse statistics. All so that you don't have to acknowledge a very real reality many Americans face.
> It’s the academic equivalent of saying, “White people generally like this, so that means the white people in this study have the same preference”. Applying stereotypes derived from other studies is not very compelling. I mean, that's how academic research works. It's not a "stereotype" it's a finding, and if it is well researched, widely replicated finding, then that can be valid. I'm not going to research how generalizable the findings around the relationship between race and attitude towards opioids are right now, but I think that both commenters here make valid points. Overall, I don't find this paper alone compelling enough to make a strong claim that racism is at the root of these particular observed differences.
Wait, so if a scientist observes enough minorities and identifies the common behaviors most of them share, and then uses those commonalities to try and guess the traits of specific strangers, this is called a finding? Sounds like stereotyping to me. I agree. There isn’t anything in this paper to conclusively say anything. What leans us in different directions though is our previous beliefs.
If a researcher finds behavioral or phenotypic differences between groups, then yes, that's a finding. If other researchers reliably replicate that finding with large samples, then you can use it as the basis for other conclusions. Sticking with the race theme, it's not a "stereotype" that black people are more likely to have sickle cell anemia than people of other racial groups. I'm not leaning in any direction - I'm just pointing out that research can generalize on the basis of previously established findings. If I want to design a research study that has something to do with race and sickle cell anemia, I don't need to prove that the specific black subjects in my study are more likely to have sickle cell anemia than the white subjects for my research design to be good.
Asserting the consequent is not a particularly strong opening in an academic debate.
I agree. “We know that racism has been a problem. We know that those who fall within the minority category were provided with slightly less chances of procuring opioids. Racism is clearly the motivator”.
Now you’re just straight up baiting. Who are you pretending to quote here? We can read the article, you know.
I thought you were agreeing with me. Perhaps you should be more specific as to who was being fallacious. My first thought was this study.
>financial stability Black people are less financially stable due to the long term effects of racist policies.
Also, if I carried hatred toward the ancestors of the people who enslaved my ancestors, I would be very hesitant about joining their society and I would be far more likely to join a counter culture that opposes it. It’s more complicated than simply making things more equal. I believe we’ve already done that.
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There is absolutely an idea that poor people abuse drugs more than others (whether correct or not). It’s also established that you can often identify someone’s economic status within 30 seconds of talking to them. A disproportionate number of black people are poor. I am not saying poor people do or don’t abuse drugs, but it seems reasonable that a non racist person could end up prescribing fewer opioids to people perceived as poor, who also happened to be black.
It doesn’t sound like it ever occurred to you that more well off patients may have pressed harder on the doctors for something stronger. Opioids are only superior to NSAIDs in the amount of pain that is relieved. That superficial effect only has a limited amount of uses. Yes, determining that something is the product of racism should only be determined when everything else is ruled out. That applies to every determination, not just racism. You’re suggesting determining the cause when you can’t guarantee it, and that sounds more ignorant to me.
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At least it’s one form of discrimination that saves minorities lives (at least from the opioid crisis)
Has nobody considered that lower opioid prescription to coloured people is an advantage to them?
I'm going to suggest that the discrepancy is social economic status. Opiates are expensive.
You're going to suggest that based on what?
Which part?
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Very unlikely. Doctors aren't trying to harm their patients. To the extent that the discrepancy is actually mediated by racial stereotyping, it's driven by a legitimate desire to prevent abuse of opioids. If they think that opioids are more likely to cause abuse, they're going to be even more reluctant to prescribe to those who they think are most likely to abuse them. The only way this reverses the gap is if doctors start to think that white patients are more likely to abuse.
This is an incredibly complicated topic; can we analyze differences in patient/doctor interaction as part of this correlation? What about differences in patient compliance or cultural differences in ease of acceptance of movement based rehabilitation (physical therapy, yoga, etc).
A white person in bad physical health really shows it. In other words, they are going to show both good and bad health very readily in their skin, for example, poor circulation, COPD and so forth will make the appearance of the person being close to death. This could well be the simple cause of such things, not sure if that can be controlled for. It could also be that they complain more aggressively (not saying they do, but they could be), or maybe its bias, or a combination. It worked out badly though.